Healthcare Provider Details

I. General information

NPI: 1295590016
Provider Name (Legal Business Name): KAYLA CARTER DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 FAIRY STREET EXT STE A
MARTINSVILLE VA
24112-1913
US

IV. Provider business mailing address

1300 WINDY RIDGE RD
MARTINSVILLE VA
24112-8395
US

V. Phone/Fax

Practice location:
  • Phone: 276-638-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024189509
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: